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Plan to overhaul Cook County health system set for vote

Independent board to vote Friday on new strategic plan

Thursday, June 24, 2010Chicago Tribuneby Judith Graham

Put more medical services in needy communities. Emphasize care that
keeps people healthy or minimizes illness. Develop partnerships with
other clinics and hospitals. Become more customer-friendly.

Those are the pillars of a new strategic plan for the Cook County Health
& Hospitals System to be voted on Friday by its independent
governing board. The blueprint then goes before county commissioners in
July.

While complete details aren't available yet, the plan is the most
important effort in years to address the public health network's
long-standing problems, among them inefficient operations, long waits
for care, abysmal financial management and a poor record of improving
the community's health.

"We know we need to redesign in a
major way the way we provide our services," said Bill Foley, the
system's chief executive.

The plan emphasizes serving more patients in outpatient clinics in city
neighborhoods while reducing Cook
County's historical reliance on expensive inpatient hospital care, a
shift that drew praise from health experts.

"This is a very necessary, progressive and positive set of moves, and
it's long overdue," said Dr. Kevin Weiss, a professor at Northwestern
University's Feinberg School of Medicine who authored a highly
critical 2006 report on the county's health system.

"They're emphasizing access to care, which I think is right" given the
extent of need in Cook
County, said John Bouman, president of the Sargent Shriver National
Center on Poverty Law, based in Chicago.

The county health system is the medical provider of last resort for
almost 800,000 county residents who don't have health insurance,
providing nearly $500 million in free care every year.

Under the plan, the county would begin offering specialty services —
such as consultations with orthopedists, endocrinologists and urologists
— at county clinics in Cicero and Cottage Grove and at a new clinic in
Arlington Heights or Des
Plaines.

Similar arrangements may also be reached with dozens of private clinics
in Chicago and its nearby suburbs. "We could provide the specialty care
while they provide the primary care," Foley said, describing potential
partnerships.

Donna Thompson, president of Access Community Health Network, the
largest chain of health centers serving low-income patients in the
region, said her organization was interested in this kind of
relationship.

"Real people are waiting in real lines for service," she said, noting a
significant shortage in specialty medical care for people without
insurance or financial resources.

More than 4,000 patients are waiting for colonoscopies
and gastrointestinal consultations at county facilities, while nearly
3,000 women are in line for gynecological checkups and almost 2,000 are
on hold for CT scans, MRIs and X-rays.

Joyce Johnsonsmith, 67, has been trying to get an eye exam through the
health system for more than two years. Every time she makes an
appointment, she said, the doctor is too busy to see her. After
experiencing physical trauma in 2008, she had to wait a year to get a CT
scan of her head.

"I was so frustrated, so scared," said Johnsonsmith, a retired county
worker who lives on a small fixed income.

Most controversial in the new strategic plan is a proposal to convert
Provident Hospital and Oak Forest Hospital into large outpatient
centers, a move that could endanger jobs at the two underused medical
centers and that has drawn strong union opposition.

"Our concern is that people won't have access" to needed hospital care,
said Christine Boardman, president of Service Employees International
Union Local 73, which represents 1,500 workers in the health system.

The situation surrounding Provident Hospital — a pioneering
African-American hospital with deep roots on the South Side — is
especially complex. If negotiations under way over a possible
relationship with the University
of Chicago Medical Center are successful, the institution would
remain largely intact.

But those talks have been rocky. If they fail, the proposed strategic
plan would significantly scale back services at Provident, which would
keep its ER open and retain a few dozen hospital beds for patients who
need to stay overnight.

The county began the process of closing Oak Forest's long-term care unit
several years ago. The fewer than two dozen patients who remain would
be placed in nursing
homes and rehabilitation facilities under the plan; the facility's ER
and hospital beds would close.

"That concerns us because this is an area where medical needs are
growing," said William McNary, co-director of Citizen Action/Illinois.

Foley acknowledged that to take care of county patients, "we would
really need to build relationships with other hospital providers" on the
Far South Side.

Also controversial, given the county's precarious finances, is a
proposal to spend $143 million over the next five years on capital
improvements for the health system: renovating facilities, strengthening
services at Stroger Hospital, rebuilding the Fantus Health Center and
building a new clinic in the northern suburbs. The sum would come from
county coffers.

Another $310 million is slated to overhaul health system operations
between 2011 and 2015, an expenditure expected to be offset by savings
at Provident and Oak Forest hospitals. Whether those savings will
materialize remains an open question.

"There will be considerably greater convenience for most patients," said
David Dranove, professor of health industry management at
Northwestern's Kellogg School of Management. But costs don't necessarily
plummet when a hospital is converted to outpatient care, he said.

The county health system's 11-member independent board was appointed two
years ago to govern the network, freeing it from political meddling
that made it a patronage haven and hampered effective management.
Earlier this month, Cook County commissioners voted to make the
independent board a permanent body.

If the board approves the strategic plan as expected, it will go before
county commissioners, who are responsible for authorizing funds for the
system. Commissioners may vote on the blueprint next month or defer a
vote until after a new board president is elected later this year.

Timing is important because the medical landscape is set to change
dramatically with the rollout of national health reforms. Hundreds of
thousands of poor, uninsured adults — the county health system's core
clients — will gain insurance cards and the ability to choose medical
providers for the first time in 2014.

If large numbers of people elect to leave the county health system, that
could prove devastating. "We've got to improve our services and improve
our infrastructure or we'll lose a large part of our patient base,"
Foley said.

Currently, many people chafe at the kind of experience Lynn Crenshaw
said she had when she was hospitalized this year for rectal cancer and
encountered nurses who wouldn't respond to her requests for help. "I was
born at Cook County Hospital, I've been going here for 41 years, I love
the doctors, but some of the staff, they're rude beyond belief," she
said.

The county health system will be moving "in the right direction" if it
adopts the new strategy that has been proposed, said Terry Conway, a
former official at the system and current managing principal at Health
Management Associates.

If the plan passes, the concern is whether the county has the commitment
and the resources to pull off implementation. "It's a great long-term
vision, but getting there is going to be really hard," said Margie
Schaps, executive director of Chicago's Health and Medicine Policy
Research Group.